Caring and communication difficulties

Communication comes in different forms, including verbal (spoken), written word, lip reading, sign language and even body language.

The person you're caring for may develop communication issues as a result of a physical condition, such as hearing difficulties or visual impairment, or as a result of a condition affecting the brain, such as Alzheimer's disease or stroke. These communication problems may come on gradually or could happen overnight, leaving you unprepared and unsure how best to communicate with the person you're caring for.

If a person's hearing or sight is impaired, body language and tone of voice will become more important. They may also need to learn new skills so they can communicate, such as sign language or lip reading.

If a condition or impairment develops suddenly, you'll need to re-evaluate your methods of communication with that person.

It might feel strange at first, but you might need to consider your tone of voice, how quickly you speak, and how you use body language and gestures to emphasise what you are saying. It's a good idea to express this to the person you care for and find out what helps them or makes your communication clearer.

Someone who has a physical or mental illness or disability may be affected by your own and other people's reactions to their condition. This could have an impact on their ability to communicate.

Causes of communication problems

Read on or click on the links to go directly to the sections on the particular difficulties carers may face:

Speech and language problems

Speech disorders are communication disorders that interrupt speech. They can result from a stammer, cleft palates, brain injuries or hearing loss, or for no known reason. Language disorders are problems understanding words or using them, such as difficulties resulting from a stroke or a brain injury.

Children learn to talk by listening to the people around them and mimicking sounds and mouth shapes. As they develop their language skills, they copy the intonation and speech patterns of those around them.

It helps to talk to your child and encourage sounds and speech from an early age. If their progress seems to be delayed, it's a good idea to take them to your doctor for a check-up.

Some people grow out of these disorders during their childhood, while others live with them throughout their adult life. Speech and language therapy can help, particularly in younger people. You can access this through your child's special educational needs co-ordinator or your GP.

For more information, watch the video below about speech and language therapy where a speech and language therapist explains how the therapy works and who can benefit from it.

Selective mutism

Selective mutism, sometimes described as a "phobia of talking", is an anxiety disorder that prevents children speaking in certain social situations, such as school lessons or in public.

However, they're able to speak freely to close family and friends when nobody else is listening – for example, when they're at home. If this affects your child, be patient and don't put pressure on them or use bribes to try to encourage them to speak. Find out more about selective mutism.

Deafblindness

Deafblind people have an impairment to both vision and hearing. Some impairments are congenital (the person is born deafblind), while others may come later in life through an accident or old age.

People who are deafblind may not communicate through words, and it can be difficult to work out the best way to communicate with them.

Sometimes deafblind people have difficulty understanding the world around them, and this can make them behave in difficult or inappropriate ways. You may find communicating with a deafblind person frustrating and slow, but with patience and trust a form of communication can develop.

The charity Sense supports and campaigns for children and adults who are deafblind.

Rehabilitation after a stroke

A stroke can cause mental and physical impairments, and make communicating with someone difficult. The person who has had the stroke may find it hard to form words or understand what someone says to them, and this may make it difficult for you to work out what they want.

If the person has problems with speech, language, writing or swallowing, they might be referred for speech and language therapy to help them regain those skills.

When communicating with someone who is recovering from a stroke, it's important to give them your full attention and try to avoid any background distractions. Try to speak clearly at a normal volume.

Make sure you are listening and watching for the person's reactions, as not all communication is verbal. It's important that you do not pretend you've understood the person if you haven't, or try to speak for them.

You can get support with stroke-related illness and disability from the Stroke Association, including information, family support, welfare and stroke clubs. The Stroke Association also has volunteers who work to improve the communication skills of people after they have had a stroke.

"Often, we do so much for people they don't have the need or opportunity to communicate. This is where 'sabotage' can come in. Put toys or important objects in a place where the person needs to ask for them; give a meal with no cutlery (again, so they have to ask). Find ways to manipulate situations to necessitate communication."

Sources of support

There are many different organisations that help people with communication problems.

The charity I CAN works to foster the development of speech, language and communication skills. They have a special focus on children with a communication disability.

Sign language

Sign language is a visual way of communicating using hand gestures, facial expressions and body language. Visual communication methods have been around for thousands of years, and nowadays there are hundreds of different types of sign languages in use across the world.

"My top tip is Makaton sign language! We are so glad we taught Zoe to use Makaton. Although she can't yet say any words, signing relieves any frustration no end – she can tell us what she wants, and the signs we use help her understand what we say. It takes a while, but it's really worth sticking with."

British Sign Language

British Sign Language (BSL) is the sign language used by deaf people in the UK. BSL makes use of hand gestures, finger spelling, lip patterns and facial expressions.

It has its own grammar that is not based upon spoken English, and even has regional dialects or variations on signs depending upon the area of the country you are in. BSL is constantly evolving in the same way that spoken English changes as new words enter the language.

Sign Supported English

Sign Supported English (SSE) is a method of communication that uses BSL signs, but the structure and grammar is based on spoken English. This means the signs follow the exact order they would be spoken in.

This variation of BSL doesn't require any knowledge of BSL grammar structure, so it is easier for hearing people to learn. It is often used in schools where deaf children are taught alongside hearing children.

Tactile signing

There are an estimated 23,000 people in the UK who are deafblind (both visually and hearing impaired). Depending on the level of their hearing and visual impairment, they may be able to hear speech, lip read, or use BSL or braille.

Makaton

Makaton is a language used by adults and children with learning disabilities and communication problems. It uses a combination of picture symbols and hand gestures that are similar to BSL and speech.

The aim of Makaton is to help people communicate through speech, so when the user is able to say the correct words they are then encouraged to speak rather than sign. Find out more on the Makaton Charity website.

Getting in touch with Carers Direct

For advice and support with communication issues over the phone, you can call the Carers Direct helpline on 0300 123 1053.

If you are deaf, deafblind, hard of hearing or have impaired speech, you can contact the Carers Direct helpline using textphone or minicom number 0300 123 1004.

Speech and language therapy

Viewing video content in NHS Choices

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A speech and language therapist explains how the therapy works and who can benefit from it.